ARTHRITIS, RHEUMATOID

General Information

DEFINITION--A long-term illness characterized by joint disease that involves muscles, membrane linings of the joints and cartilage.

BODY PARTS INVOLVED--Joints, including cartilage, synovial membranes, muscles and ligaments; blood vessels; eyes.

SEX OR AGE MOST AFFECTED--3 times more common in women than men. It begins between ages 20 and 60, with a peak incidence between ages 35 and 45.

SIGNS & SYMPTOMS--

Slow or sudden onset of:

• Redness, pain, warmth and tenderness in any or all active joints in the hands, wrists, elbows, shoulders, feet and ankles.
• Morning stiffness.
• Low-grade fever.
• Nodules under the skin (sometimes).

CAUSES--Unknown, but probably an autoimmune disease.

RISK INCREASES WITH

• Family history of rheumatoid arthritis or other autoimmune disorders.
• Genetic factors, such as autoimmune-system defects.
• Female age 20-50.
• Native American ethnicity (prevalence is higher in this group).

HOW TO PREVENT--No specific preventive measures.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and physical exam by a doctor, x-rays of joints.
• Laboratory blood studies to detect a rheumatoid factor.

APPROPRIATE HEALTH CARE

• Self-care after diagnosis, doctor's treatment, physical therapy.
• Surgery such as synovectomy, joint reconstruction or total joint arthroplasty may be necessary in advanced disease. (See Arthroplasty, Knee; Arthroplasty, Hip; Arthroplasty, Shoulder in Surgery section.)

POSSIBLE COMPLICATIONS

• Impaired vision.
• Permanent deformity and crippling.
• Drugs used in treatment can induce complications, such as gastric problems, and those associated with long-term steroid use.

PROBABLE OUTCOME--The disease may be mild or severe. It is incurable, but pain relief, prevention of disability and an active, normal lifespan are usually possible with early diagnosis. Conservative treatment relieves symptoms in 1 year in 75% of patients. About 5% to 10% are eventually disabled, despite treatment.

How To Treat

GENERAL MEASURES--

• Major changes in life-style will be necessary. Try to perform as many activities of daily living as possible. Physical therapy and occupational therapy will be provided.
• Splints at night may be helpful to support and protect a joint. Ask your doctor.
• Gloves at night to retain heat.
• Relieve pain with heat, including hot soaks, heat lamps, heating pads or whirlpool treatments.
• See Resources for Additional Information.

MEDICATION--Your doctor may prescribe: nonsteroidal anti-inflammatory drugs, including aspirin and other salicylates; gold compounds; immunosuppressive drugs. Cortisone drugs usually relieve pain dramatically for short periods, but they are less effective for long-term use. They don't prevent progressive joint destruction, and they sometimes have hazardous side effects. Cortisone injections into joints can temporarily relieve pain.

ACTIVITY--

• Stay in bed, except to use the bathroom, until fever and other signs of an active flare-up disappear.
• Remain active, but include daily rest periods. Sleep for 10 to 12 hours each night. Don't become overtired.
• Stand, walk and sit erectly.
• When able, exercise actively to preserve strength and joint mobility. Build up slowly to the amount suggested by your doctor and physical therapist.
• Exercise disabled joints passively to help prevent contractures.

DIET--Eat a normal, well-balanced diet. Avoid arthritis diet fads. Lose weight if you are obese (see Weight Loss Diet in Appendix). Obesity stresses the joints.

Call Your Doctor If

• You have symptoms of rheumatoid arthritis.
• The following occurs during treatment: Fever. Symptoms appear in unaffected joints.
• New, unexplained symptoms develop. Drugs in treatment may produce side effects.